[Dysphagia] acoutsic neuroma resection

[bonnieh4455 at sbcglobal.net (Bonnie Heintskill)]

I have a patient who had an acoustic neuroma resected in January 2005. It was done by Gamma knife and damaged not only the 8th nerve, but also the 7th, 9th and 10th nerves. He has a cuffed trach and has a g-tube. Was in rehab in two different hospitals and a SNF.  He had collagen injections of the right vocal cord in January then had it aspirated out (I'm assuming that's what the reports mean) plus nerve and muscle grafts which were unsuccessful.

I have him now for homecare. I've been doing oral stim via thermal stim, taste sensation, tapping on his face, and neuromuscular retraining.  This will be the 3rd week I will be treating. He had a poor swallow when I initially eval'd him but now, has no swallow. He also has right sided weakness (possible stroke after surgery?). He saw the ENT  a week ago and was scoped. The right vocal cord is paralyzed in the open position.

Home care nurse went in with me on Wed and deflated his trach cuff, which he did NOT tolerate very well - major coughing, what looked like/sounded like sneezes. He had to keep suctioning orally and still had difficulty until the nurse reinflated his cuff. He has maxed out for OT/PT and nursing. I have checked with local hospitals in his area for other types of treatment (DPNS, Vitalstim, EMG feedback). One hospital does the DPNS and Vitalstim so all the therapists and RN have agreed he should be discharged to outpatient therapy so he can get more specialized OT/PT/ST.

Insurance has limited coverage (contrary to what spouse is saying) for therapies.

Have I missed anything?

Thanks
Bonnie Heintskill, MS, CCC/SLP